1617 Clemson Dr B410111'
CityofEaaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
SEP 10CD1
Use BLUE or BLACK Ink
Permit#: c - c-
"�01
/ Pi
Permit Fee:
Date Received:
Staff:
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: t - ,-1 b Site Address: 1In \ - N'1(----1
Tenant: avtA
�L.ArY wY1 Suite #:
RESIDENT / OWNER
Name: V\0\_1(1) i\V WT \ V`Y�1M Phone:J °- - Ll J
Address / City / Zip: \ l o \ —1 - 3 C....\ v 'Zr �CZ
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: :S(UCGC QMI ;Dtt ' '. .
Construction Cosh lU,C 11 Multi -Family Building: (Yes / No )
CONTRACTOR
Named .C. Or ---L -'S zit-sc.-AS License #:
Address: `t0' r v, K.V'u. a ,c 1\ve , City:Cr--.�--\
State: NAN Zip: '5 \"i J Phone: LtS \ - Z `/ ' Q 75 7:9--
Contact: Z_ Email:
COMPLETE
In the last 12 months, has
Yes If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a penult for a similar plan based on a master plan?
date and address of master plan:
_No
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit ane considered to be pubtic tufa lrmatlon. Po� Of
the information may be classified as non-public if you pmvlde specific reasons would p the City t+
conclude that they ars trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Applicants Printed Name
AlSplicantSignature
Page 1 of 2
,-\
/‘/-7
647)_<07A b4 -
DO NOT WRITE BELOW THIS LINE
q61-7(
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
T Accessory Building
WORK TYPES
New
Addition
Alteration
cC, Replace
// Retaining Wall
DESCRIPTION
Valuation
Plan Review
Fireplace
Garage
Deck
Lower Level
_ Interior Improvement
_ Move Building
Fire Repair
Repair
(25%_ 100% )
Census Code (`
# of Units
# of Buildings
Type of Construction
vis
REQUIRED INSPECTIONS
Footings (New Building)
_ Footings (Deck)
_ Footings (Addition)
Foundation
Drain Tile
_ Roof: _Ice & Water Final
'`C Framing
_ Fireplace: Rough In Air Test
Insulation
Meter Size:
Reviewed By:
Porch (3 -Season) _
Porch (4 -Season) _
Porch (Screen/Gazebo/Pergola) T
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Siding
Reroof
Windows
_ Egress Window
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
_ Demolish Building*
Demolish Interior
Demolish Foundation
;.> Water Damage
*Demolition of entire building — give PCA handout to applicant
N )4) 7
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Sheetrock
Final / C.O. Required
y Final / No C.O. Required
HVAC
Other:
Pool: Footings Air/Gas Tests _Final
Siding: _Stucco Lath Stone Lath Brick
_Final Windows
Retaining Wall: _ Footings _ Backfill _ Final
Radon Control
Erosion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 2
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.ci.eagan.mn.us
PERMIT
City of En
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Mechanical
EA084441
07/17/2008
ePermit
Site Address: 1617 Clemson Dr B
Lot: 2 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-020-02
Use:
Description:
Sub Type: e - Fumace & Air Conditioner
Work Type: New
Description: Fumace & Air Conditioner
Comments: Questions regarding electrical perm
952-445-2840.
Permit expired without required inspections. 4/9/2009 CE
equirements should be directed to Mark Anderson, State Electrical Inspector,
Fee Summary:
ME - Permit Fee (Replacements)
Surcharge -Fixed
$50.00 0801.4088
$0.50 9001.2195
Total:
$50.50
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881-7739
- Applicant -
Owner:
Mary Ann Timm
1617 Clemson Dr B
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Applicant/Permitee: Signature
Issued By: Signature
City of Eagan
Eagan,
PERMIT
City of Eaan
Permit Type: Building
Permit Number: EA104523
Date Issued: 05/25/2012
Permit Category: ePermit
Site Address: 1617 Clemson Dr B
Lot: 2 Block: 02 Addition: The Trails Of Thomas Lake
PID: 10-75865-02-020
Use:
Description:
Sub Type: e-Windows/Doors
Work Type: Windows/Doors-New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Construction Type:
Occupancy:
Comments:
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary:
Valuation: 4,000.00
BL - Base Fee $4K
$103.25
Surcharge - Based on Valuation $4K $2.00
0801.4085
9001.2195
Total: $105.25
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
- Applicant -
Owner:
Mary Ann Timm
1617 Clemson Dr B
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
..ITY OF EAGS$N
3830 Pilot Knob Road
P.O. Box 21199 DATE:
Eagan, MN 55121
zoning: No. of Units: 1 unit
z 071 4ple'
---- -
Owner: _---
Address:
Site Addess:
n _
Plumber: .r — --
Meter No.:
Size:
Reader No.:
I agree to comply with the City of Eagan
Ordinances.
WATER SERVICE PERMIT
342`:
PERMIT NO.:
?713 7
By
it
Connection Charge:
Account Deposit: -- Permit Fee:
Surcharge:
Misc. Charges: ---
Total:
(g Date Paid:
Insp.:
Date of Insp..
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road PERMIT NO.:
P.O. Box 21199
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner
Address.
Site Address.
Plumber.
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
City of Eagan
PERMIT
City of Eaan
Permit Type: Plumbing
Permit Number: EA109373
Date Issued: 02/28/2013
Permit Category: ePermit
Site Address: 1617 Clemson Dr B
Lot: 2 Block: 02 Addition: The Trails Of Thomas Lake
PID: 10-75865-02-020
Use:
Description:
Sub Type: Residential
Work Type: Replace
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Kris Dien
3670 Dodd Rd
Eagan, mn 55123
651-365-1340
Fee Summary:
PL - Permit Fee (WS &/or WH) $55.00
Surcharge -Fixed $5.00
0801.4087
9001.2195
Total: $60.00
Contractor:
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
- Applicant -
Owner:
Mary Ann Timm
1617 Clemson Dr B
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
City of Eapil
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #:
i4q LP
Permit Fee:
Date Received: CI IN S I
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
J
q/a'// 3 site Address: /07 rn /'bilis 4/i0k 173 (q Lt *5r 9 6 l e unit #:
Date: � � 3 �
Resident/
Owner
Name: TN/ L of- (/140M9 -i L,K, [-i. A / . Phone19 7f17 7Sj/
Address / City / Zip: r+174/ f
Applicant is: Owner Contractor
Type;ofWork
Description of work: tit`/ goo( ` l'/CCC /iv 16 firCCS D t ..1 &Ivy
i€ 4t 7 /4
I"
Construction Cost:.(9-•-g..072---- .. ....___lilt-Famity- i#ding. (Yes fNo- )
i
Contractor
v :
TLB �-' . -1 h o, t -,prie
Company: Contact:
q,39 urL_i�, l w1 Ci t N ntixa o
Address: City:
in(‘ 53a~2-7(17- 75 -/
State: Zip: • Phone:'
B c. i 22: � R a�, NAT -2-3D.90 — 1
.LI
-Liccnsc #:• — — Lead Certificate #:
If the, project is exempt from lead certification, please explain why: (see Page 3 for additional information)
ifrd /2 , -'t he,,,‘f� D,Frvpi-e) - Vi nay 1 c f%/t>
In the' ast 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
'G Vb .^�r'� �4 s �s '�s
NOT Mans and supporting documents.ihat,you ubm( pare ci s[de,red foVbe p ,rbl c nnformat► n- Port ons of
�r r..#r t+ -.L ---.,.
. ®rrnation maybe clasifiedvas non•-�publ�c-[f you�pr tilde specific yeas' hs that�would pent, [ty
the) . - ` coneludl That the ; arre tr cle, sea"rets:'a""
CALL BEFORE YOU DIG. Call Gopher State One CaII at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www. gooherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that "I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance', with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issua e.
xi es low
fie. x
Applica s Printed Name Ap icant's Signature
/L1
Page 1 of 3
City of Eagan
PERMIT
41' City of Eaan
Permit Type: Building
Permit Number: EA148511
Date Issued: 04/03/2018
Permit Category: ePermit
Site Address: 1617 Clemson Dr B
Lot: 2 Block: 02 Addition: The Trails Of Thomas Lake
PID: 10-75865-02-020
Use:
Description:
Sub Type: Fireplace Construction Type:
Work Type: Gas Insert
Description:
Census Code: 434 - Residential Additions, Alterations Occupancy:
Zoning:
Square Feet: 0
Comments:
Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:
Valuation: 3,000.00
BL - Base Fee $3K
$88.50
Surcharge - Based on Valuation $3K $1.50
0801.4085
9001.2195
Total: $90.00
Contractor:
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(651) 633-2561
- Applicant -
Owner:
Cheryl Pistulka
1617 Clemson Dr B
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA156224
Date Issued:06/20/2019
Permit Category:ePermit
Site Address: 1617 Clemson Dr B
Lot:2 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-02-020
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Cheryl Pistulka
1617 Clemson Dr B
Eagan MN 55122
(651) 238-8966
Gladstone's Window & Door Store
2475 Maplewood Drive
Suite 110
Maplewood MN 55109-0000
(651) 774-8455
Applicant/Permitee: Signature Issued By: Signature